Living in the Shadows: Illiteracy in America
Millions Live With a Crippling Secret That Affects Their Everyday Lives

By PIERRE THOMAS, JACK DATE and THERESA COOK

Feb. 24, 2008 --

It's a chronic crisis of huge proportions, one that keeps millions of
Americans living in the shadows. And for nearly all of her of 45 years,
Monica Baxley had lived with the crippling secret.

"I cried a lot over this," she said, "when I was alone and just would wonder
what could be done, you know, if there was any help out there for me."

Baxley, of the Florida panhandle town of Chipley, was functionally
illiterate. She quit school in the ninth grade, and for 30 years kept her
secret from friends, family and even her husband.

"I didn't want to be exposed, beyond anything else. That was the most
important thing -- for no one to ever learn."

Baxley joins so many others with literacy challenges: 7 million Americans
are illiterate, 27 million are unable to read well enough to complete a job
application and 30 million can't read a simple sentence.

Her travel was limited because she was unable to read road signs. She was
unable to read a newspaper or food labels in a supermarket.

Baxley never voted in an election. "I didn't know who or what to vote for,"
she said.

Her illiteracy even impacted her physical health, as she avoided seeing the
doctor out of fear she would have to fill out a medical form or read a
prescription.

"My health is poor now, but I really believe that's because I never went to
the doctor and had my physicals and stuff that I should have had," Baxley
admitted.

A recent study from the Archives of Internal Medicine revealed patients who
had difficulty reading prescriptions were 50 percent more likely to die from
disease than patients who were literate.

"It is a life and death issue," said study author Dr. David Baker of
Northwestern University. "Literacy affects your health in so many different
ways," he said, from inability to properly follow instructions to not
knowing about common conditions or what symptoms to look for.

"So when you put all of these things together it's not surprising that
people with the lower literacy levels are more likely to die [earlier],"
Baker said.

Baker said his team has interviewed hundreds of patients about their
experiences, and Baxley's situation was a common theme -- hiding illiteracy
from those close to them.

"It's very scary for people" when their first contact with the healthcare
system involves filling out detailed medical forms. "That's not a great
start," Baxter said, "and then when they are seeing their doctor they're
given other information they don't understand" such as prescription
information and instructions to take care of themselves.

"Many people are afraid to come in and see the doctor," Baxter said. They
don't seek care, resulting in the worsening of their conditions and an
increased likelihood of trips to the emergency room.

The American Medical Association Foundation did a private study of patients
who could not read. One woman who provided a testimonial said signed a form
agreeing to a medical procedure with no idea what it meant.

"The nurse said, how are you feeling since your hysterectomy?" according to
the testimonial. "And I acted as normal as I could, but inside, my mouth
fell open and I thought to myself, how could I be so stupid as to allow
somebody to take part of my body and I didn't know it?"

Another patient took her medication improperly, afraid to tell her physician
about her difficulty reading.

"I didn't take it right. I admit it," her testimonial said. "I just didn't
have they nerve to ask them and I didn't want anyone to know I couldn't
read."

"It's a tremendous problem when you think about the costs for us,
economically, health-wise," said Sandra Baxter, director of the National
Institute for Literacy.

"For so many adults who don't have the education, it's embarrassing to have
to say, would you explain that to me?" Baxter said of potential problems
during a doctor appointment. "And so they don't ask the questions that they
need to."

Undiagnosed learning disorders, poverty and an unstable home life are all
factors.

As for Monica Baxley, she confronted her illiteracy at age 42 and learned to
read. But illiteracy persists for millions who continue to live with it in
the shadows.

If someone you know needs help, contact your local library, or use one of
the following resources:

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